Relationship between left ventricular mass and noninvasive monitoring of blood pressure.

We studied the relationship between left ventricular mass index (LVMI) and blood pressure (BP) monitored during 24 hours in 35 normotensive and 58 hypertensive patients with no treatment for more than three months. We found a close correlation between LVMI and the average daytime systolic BP (r = 0.68). Other parameters derived from BP monitoring were also correlated with LVMI: daytime diastolic BP (0.54), nighttime systolic and diastolic BP (0.61 and 0.54), pulse pressure (0.58), the average of the five highest systolic and diastolic BP (0.57 both), and the percentage of systolic BP above 140 mm Hg (r = 0.64). However, in a stepwise multiple regression analysis only daytime systolic BP was independently correlated to LVMI. The standard deviation of systolic BP was not significantly correlated to LVMI. The same positive correlation between daytime systolic BP and LVMI was found in normotensive and hypertensive patients, males and females, and patients with and without left ventricular hypertrophy. So, at least regarding the prediction of the degree of left ventricular hypertrophy, the average systolic BP during daytime seems to be the only valuable parameter to look at in ambulatory BP monitorings of untreated hypertensive patients.

Captopril test in the detection of renovascular hypertension in a population with low prevalence of the disease. A prospective study.

The value of the captopril test as a screening test for identifying renovascular hypertension has been outlined by several studies performed in populations with a high prevalence of renovascular disease (20% to 50%). We prospectively assessed the value of the test in 103 hypertensive patients referred to our center for evaluation of their hypertension. They had taken no diuretics and no converting-enzyme inhibitors for more than four days. The interpretation of the results of the test was done according to the criteria defined by Muller et al. All patients underwent a digital venous angiography and when positive or doubtful, a conventional angiography. Eleven patients (10%) had unilateral or bilateral artery stenosis greater than 70%. The sensitivity of the test was 73% with a specificity of 84% and a positive predictive value of 35%. The three patients with a false negative test underwent a surgical treatment or a transluminal angioplasty of the stenosis but remained hypertensive. Thus, the captopril test is a useful screening test for identifying patients with renovascular disease, even in a population with a low prevalence of the disease.

[Circadian rhythm of blood pressure. Importance of the severity and not the cause of arterial hypertension]. / Variations circadiennes de la tension artérielle. Importance de la sévérité et non de la cause de l'hypertension artérielle.

Recent work have raised the possibility of a lack of circadian blood pressure variability in secondary hypertension. To test this hypothesis, we compared 11 patients with renovascular hypertension (RVH) and 11 essential hypertensive patients (EH) matched for sex, age, body weight, height and the average level of SBP from 7 a.m. to 10 p.m. monitored every 15 minutes with a Spacelabs 5200 device. All patients had BP monitored during 24 hours, inside the hospital, after all anti-hypertensive drugs were discontinued for more than 5 days. Paired t test revealed no difference between the two groups. Differences (D - N) between average day time (7 a.m.-10 p.m.) and night time (10 p.m.-7 a.m.) systolic and diastolic BP were not different in the two groups. (Table: see text). To test the influence of BP level on circadian BP variation, we studied the correlation between the difference in day and night average SBP, as a % of average day time SBP, and the average day time SBP in 25 normal subjects and 64 hypertensive patients without treatment. A weak but significant correlation was demonstrated (r = -0.29; p less than 0.01). The higher the average day time SPB, the lower the difference between day and night. In conclusion, circadian variation of BP is not different between essential and renovascular hypertensive patients, but there is a trend to a smaller variation in patients with the higher BP.

[Association of sacciform aneurysm of the renal artery and hypertension. Cause or coincidence? Apropos of a case]. / Association anévrysme sacciforme de l'artère rénale et hypertension artérielle. Cause ou coïncidence? A propos d'un cas.

Aneurysms of the renal artery are seldom encountered. They present as different aetiopathological types. We report the case of a female patient who had both severe arterial hypertension and an apparently dysplastic aneurysm of the right prepyelic artery. Resection of the aneurysm failed to have the effect we expected on arterial hypertension. The relationship between arterial hypertension and aneurysm of the renal artery is discussed.

[Cardiac Doppler ultrasonography in the diagnosis and surveillance of chronic aortic insufficiency]. / Place de l'écho Doppler cardiaque dans le diagnostic et la surveillance des insuffisances aortiques chroniques.

Chronic aortic insufficiency is, since a few years, a topic of renewed interest because of the development of non-invasive monitoring methods: sonocardiography, cardiac Doppler. The problem raised is that of deciding the most opportune time for surgery in asymptomatic chronic AI, the course of which may quietly evolve towards irreversible myocardial lesions. The severity of AI may be determined by numerous sonocardiographic and Doppler criteria. In sonocardiography, three types of parameters have especially been studied: ventricular expansion (telediastolic, telesystolic diameter), the systolic function (percentage of diameter decrease), volume/mass ratio (R/h). To be valid, these measurements are a precious guide for patient's monitoring and therapeutic approach. The more recent Doppler criteria must be validated on large series and evaluated according to the context or a pathological association; they all have limitations and cannot be interpreted separately.

[Value and limitations of the measurement of the jet diameter in aortic insufficiency using Doppler color. Report of 68 patients]. / Valeur et limites de la mesure du diamètre du jet de l'insuffisance aortique en Doppler couleur. A propos de 68 patients.

The aim of this study is to specify the feasibility and value of the diameter measurement of the jet of aortic insufficiency (AI) in colour Doppler. 68 consecutive patients had a supra-sigmoid angiography and a colour echo-Doppler. An aortic insufficiency was revealed 58 times by the angiography and Doppler. In all the cases except four, it has been possible to measure the jet diameter at the origin in para-sternal incidence in colour TM by confronting the images in great and small axis section. The Doppler results have been compared to the angiographic score in 4 grades according to Sellers classification. The jet diameter at the origin in colour TM is significantly different in groups I, II, III-IV. In the group III-IV, it is always higher or equal to 13 mm. The failures of quantification of the AI jet in colour Doppler are linked with the very eccentric nature of the jet or to the poor quality of the echo-Doppler imaging. On the whole, the jet diameter measurement proves to be a very useful element in the assessment of the gravity of an AI, particularly when it is a central and circular jet.

Nucleotide sequence of Acinetobacter baumannii aphA-6 gene: evolutionary and functional implications of sequence homologies with nucleotide-binding proteins, kinases and other aminoglycoside-modifying enzymes.

A new kanamycin-resistance gene, detected in Acinetobacter baumannii and designated aphA-6, was sequenced. It specifies a 30319 Dalton 3'-aminoglycoside phosphotransferase (APH(3'] that mediates resistance to kanamycin and structurally related aminoglycosides, including amikacin. Pairwise comparisons of the six types of APH(3') so far detected in human pathogens (types I, II, III and VI) and in amino-glycoside-producing microorganisms (types IV and V), confirm that APH(3') enzymes have diverged from a common ancestor. Three highly retained motifs (1: V--HGD----N; 2: G--D-GR/K-G and 3: D--K/R--Y/F---LDE) located in the C-terminal part of the enzymes were defined. Screening of protein sequence data bases fore each of these motifs revealed that motifs 1 and 2 are both found in nucleotide-binding phosphotransferases associated with a variety of biological processes, namely adenylate kinase, viral oncogenic protein kinases, elongation factors, Na+/K+-transporting ATPase, myosin and antibiotic-modifying enzymes. Motif 2 probably corresponds to the MgATP binding site, while motifs 3 and 1 could be involved in the splitting of the phosphodiester bond and in the phosphate transfer, respectively. Moreover, an additional motif, almost invariably centrally located, was found in all aminoglycoside-modifying enzymes. The occurrence of this motif, possibly a recombination site which would have allowed the association of units of separate functions, is compatible with a modular concept for the structure of aminoglycoside-modifying enzymes.